The Hawaii State Department of Health (DOH) has confirmed three additional cases of Legionnaires’ disease at The Queen’s Medical Center in Honolulu. One of the four patients being treated for the disease died in May after being hospitalized.

The news comes a week after the DOH announced an investigation into an individual case of Legionnaires’ disease, a potentially fatal type of pneumonia.

The DOH is working with the Centers for Disease Control and Prevention (CDC) to locate the source of the illness, both inside and outside the hospital, according to state health officials.

Environmental samples were collected at The Queen’s Medical Center (QMC) by the DOH to see whether the hospital is the source of Legionella bacteria, which causes the sometimes-deadly respiratory illness. According to the CDC, one in 10 patients infected with Legionnaires’ will die from the disease.

The ages, gender and current conditions of the patients infected with Legionnaires’ was not released, although it has been confirmed that they are being treated at the hospital. It is believed that two cases were the result of community-acquired illnesses, and the other two were sickened by Legionella after being admitted.

The DOH is trying to determine if the cases are linked by a common source of infection.

A QMC spokesperson said the hospital is proactively asking all health-care providers to take additional precautions with patients at greatest risk of contracting the disease and recommending that high-risk patients avoid exposure to tap water at the medical center.

They advised that patients temporarily avoid the following, under state and federal guidelines:

  • drinking water from a fountain
  • using ice from the ice machine
  • taking showers
  • flushing toilets.

Additionally, the QMC has undertaken the following preventative measures to ensure the safety of its patients and staff:

  • increased chlorination of water
  • increased surveillance of water cultures and testing in conjunction with DOH and water experts
  • replacement of laminar flow devices on faucets
  • scheduled running of showers and faucets as part of routine room cleaning.

Six of the eight confirmed cases of Legionnaires’ in Oahu this year were residents of the island, according to the DOH.

Residents or visitors to Oahu or the QMC exhibiting pneumonia- or flu-like symptoms should seek immediate medical attention from their health-care provider.

The Queen's Medical Center
The Queen’s Medical Center.
Photo: Honolulu Star-Advertiser file photo.

Legionnaires’ 101

Anyone can become ill from Legionella, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, both current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

What are the symptoms?
Legionnaires’ disease is similar to other types of pneumonia. Symptoms can even resemble those of flu, which is why it often goes under-reported.

Symptoms can include:

  • cough
  • shortness of breath
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.
Where do Legionella live?
Outbreaks have been linked to a number of sources:

  • water systems, such as those used in hospitals, nursing homes, and hotels
  • showers and faucets
  • equipment used in physical therapy
  • hot tubs and whirlpools
  • mist machines, hand-held sprayers, and ice machines
  • swimming pools
  • decorative fountains
  • hot-water tanks and heaters
  • large plumbing systems
  • the cooling towers of air conditioning systems.

How is Legionella contracted?
Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of lung infection. According to the CDC, an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur yearly in the U.S. Only 5,000 cases are reported, however, because of its nonspecific signs and symptoms.

Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.